1. www.uwosh.edu/ccdet1 CBRF Medication Administration Training Developed by: University of Wisconsin Oshkosh CCDET Approved by: Wisconsin Department of Health Services Division of Quality Assurance Bureau of Assisted Living March 1, 2014

2. www.uwosh.edu/ccdet2 Training Topics Resident Rights Legal Responsibilities Facility Policies and Procedures Delegated Procedures Medication Management Medical Terms and Abbreviations Medication Packaging, Labeling and Storage Types of Medications Medication Administration

3. www.uwosh.edu/ccdet3 SECTION I: INTRODUCTION TO MEDICATION ADMINISTRATION  Under certain conditions  After successful completion of this training course CBRF resident assistants (RAs) may administer medication to residents:

4. www.uwosh.edu/ccdet4 Role of the Caregiver  Approximately 800,000 drug-related injuries occur in U.S. long-term care facilities every year  Errors occur at many levels  Most are preventable

5. www.uwosh.edu/ccdet5 Honoring Resident Rights Residents have the RIGHT to:  Receive medication as prescribed  Refuse medication  Participate in planning  Refuse care and treatment  Make decisions

6. www.uwosh.edu/ccdet6 Med Administration Differences  Staff-administered with supervision  Staff-administered without supervision  Self-administered by resident Activity: Residents’ Rights and Medication Administration Ways that medication can be administered :

7. www.uwosh.edu/ccdet7  CBRFs and staff regulated by Wisconsin law  Division of Quality Assurance roles  Dept. of Safety and Professional Service roles  CBRF legal requirements Legal Issues

8. www.uwosh.edu/ccdet8 Allows RNs to:  Delegate tasks  Provide direction and assistance  Observe and monitor  Evaluate Nurse Delegation

9. www.uwosh.edu/ccdet9 Delegated/Supervised by RN Description InjectionUsing a needle Rectal or Vaginal Into the rectum or vagina Nebulizer Inhaled as a vapor from a machine StomaThrough a stoma Enteral“Feeding” tube Medication Administration Procedures

10. www.uwosh.edu/ccdet10 Training and Supervision Related to Delegated Tasks Conditions that must be met:  You must be trained  Perform nurse delegated-tasks that are EXACTLY the same as your training Activity: Delegated Tasks

11. www.uwosh.edu/ccdet11 SECTION II: THE FACTS ABOUT MEDICATIONS This section covers:  Types and forms of medications  Factors that can affect medications  Classes of medications  Pain management systems

12. www.uwosh.edu/ccdet12 Forms You May Administer when Delegated by an RN InjectablesDouches SuppositoriesEnemas Forms You May Administer After Completing this Training Tablets (or pills)Aerosols or inhalers CapsulesTransdermal patches LiquidsDrops PowdersOintments/salves/sprays Dosage Forms

13. www.uwosh.edu/ccdet13 Purposes and Effects- Medication Terminology  Drug indication  Drug effect or action  Side effect  Drug allergies  Specific administration information

14. www.uwosh.edu/ccdet14 Factors that Impact Drug Effectiveness  Age  Drug interactions  Fluids  Renal function  Gender Activity: Drug Effects

15. www.uwosh.edu/ccdet15 Classes of Commonly Used Drugs AnalgesicAntifungal AntibioticAntiparkinson AnticoagulantAntipsychotic AntidepressantCardiovascular AntidiabeticCholesterol

16. www.uwosh.edu/ccdet16 More Drug Classes Cognitive EnhancersRespiratory GastrointestinalSedative OphthalmicHypnotic OsteoporosisThyroid Urinary Incontinence Activity: Using the Drug Classification Reference Tool

17. www.uwosh.edu/ccdet17 Medical Abbreviations  Error-prone  Easy to misinterpret  Ask if you’re not sure  PRN Medications Activity: Understanding Abbreviations  Do Not Use List

18. www.uwosh.edu/ccdet18 Generic vs. Trade Name Drugs  Generic = New drug name  Trade = Brand name  Medications: Look Alike/Sound Alike Activity: Look Alike/Sound Alike Medications

19. www.uwosh.edu/ccdet19 Pain Management  Causes of Pain  Pain Management Scales Numeric Pain Assessment Tool Wong-Baker Faces Pain Rating Scale  Checklist of Non-Verbal Indicators  Facility Policy

20. www.uwosh.edu/ccdet20 Pain Management Medication Acetaminophen  Mild pain Non-steroidal anti- inflammatories (NSAIDs)  Mild to moderate pain Opioids  Severe and chronic pain

21. www.uwosh.edu/ccdet21 Controlled Substances  Millions of Americans use prescription drugs for non-medical reasons.  “Diversion” means using a drug for another purpose or person

22. www.uwosh.edu/ccdet22 Federal Controlled Substances Act Schedule I High potential for abuse – no accepted medical use Schedule II High potential for abuse – an accepted medical use Schedule III Lower potential for abuse than I or II Schedule IV Lower potential for abuse than III Schedule V Lowest potential for abuse

23. www.uwosh.edu/ccdet23  Opioids – pain  CNS Depressants – anxiety and sleep disorders  Stimulants -sleep disorders and ADHD Commonly Abused Prescription Medications

24. www.uwosh.edu/ccdet24 Increasing Awareness: What Caregivers Can Do  Watch for red flags of drug abuse or medication diversion  Don’t enable the abuser Activity: Developing Best Practices Activity: Applying Best Practices

25. www.uwosh.edu/ccdet25 Reporting Drug Diversion Wisconsin’s Caregiver Law:  Abuse or neglect  Misappropriation of property Criminal Charges and Penalties:  Caregiver misconduct  Criminal violation  Permanent record

26. www.uwosh.edu/ccdet26 SECTION III: MEDICATION MANAGEMENT Medication Administration System CBRF Policies and Procedures should cover:  Administrative records  Orders  Packaging requirements  Labeling

27. www.uwosh.edu/ccdet27 Medication Administrative Records The MAR is a written record of each resident’s medication regimen including:  Prescription drugs  Over-the-counter medications  Dietary supplements

28. www.uwosh.edu/ccdet28 Medication Orders DHS 83 requires a physician’s or practitioner’s order in each resident’s chart or record for all prescription or over-the-counter medications.  Transcription of Orders

29. www.uwosh.edu/ccdet29 Medication Packaging and Labeling Requirements  Unit Dose Packaging  Medication Samples  Labeling Requirements  Medication Transfers  Expiration Dates Activity: Review of Medication Packaging and Labeling

30. www.uwosh.edu/ccdet30 Medication Procedures and Documentation  Required Documentation  Special Requirements for PRN Psychotropic Medication  Other Reporting and Documentation

31. www.uwosh.edu/ccdet31 Medication Errors Causes of Medication Errors  Wrong medication  Wrong dose  Wrong time/omission  Wrong route  Wrong technique Activity: Recognizing Medication Errors Ways to Prevent Errors

32. www.uwosh.edu/ccdet32 Medication Storage  Staff- vs. Self-Administered  Refrigeration  Chemicals  Internal/External Separation  Controlled Substances  Record/Auditing

33. www.uwosh.edu/ccdet33 Destruction & Disposal of Medication  Medications go with resident upon discharge  CBRF must have policy for disposing other types of medication  Witnessing and/or signing a medication destruction form is a big responsibility Activity: Med Storage & Disposal

34. www.uwosh.edu/ccdet34 CBRF Review and Monitoring Responsibilities CBRF Responsibilities:  Medication regimen review  Medication review for scheduled psychotropic medication  Annual review requirements  Other monitoring to assure oversight

35. www.uwosh.edu/ccdet35 SECTION IV: MEDICATION ADMINISTRATION  Follow requirements  Know which meds you may or may not administer  Completing this course vs. nurse delegation  Understand medications  Understand ordering, packaging, labeling, etc.  Use all resources available to you

36. www.uwosh.edu/ccdet36 1.Right Individual 2.Right Drug 3.Right Dose 4.Right Time 5.Right Route 6.Right Documentation The Six Rights of Medication Administration:

37. www.uwosh.edu/ccdet37 Standard Precautions Ways of doing your work to lower the chance of spreading disease  Hand hygiene  Protective equipment  Care of the environment  Safe injection practices

38. www.uwosh.edu/ccdet38 Routes and Procedures Demonstration 1.Oral Medications 2.Oral Inhalers 3.Eye/Ophthalmic Drops 4.Eye Ointment 5.Ear Drops 6.Nasal Medications 7.Transdermal Medication Patches 8.Topical Medications

39. www.uwosh.edu/ccdet39 Using the Medication Administration Record Time and daySpecial instructions Medication name & dosage PRN orders RouteDocumentation Activity: Review the record

40. www.uwosh.edu/ccdet40 M edication Administration Process Steps  Unlock the cabinet/cart  Observe 5 medication rights  Check 3 times  Practice hand hygiene  Put on gloves  Inform the resident  Be respectful

41. www.uwosh.edu/ccdet41 More Medication Administration Process Steps  Administer meds  Allow the resident to assist  Observe the resident  Remove gloves  Repeat hand hygiene  Document required information Activity: Administering Medications Activity: Understanding the Medication Process

42. www.uwosh.edu/ccdet42 Training Topics Review Resident Rights Legal and Ethical Responsibilities Facility Policies and Procedures Delegated Procedures Medication Management Medical Terms and Abbreviations Medication Packaging, Labeling and Storage Types of Medications Medication Administration